From Controversy to Conversation: Medicinal Marijuana and Dentistry

Speaker: Assistant Professor Anna Matthews, RDH, MS , Assistant Professor Sandra Stramoski, RDH, MSDH

Course Details:

Despite the growing evidence of its usefulness in management of cancer, HIV/AIDS, epilepsy and other neurological disorders, marijuana remains illegal under the U.S. federal law.

It is a Schedule I controlled substance and has no acceptable medical use according to the U.S. Drug Enforcement Administration. However, many states, as well as other countries, have approved its use for medicinal purposes and a growing number of jurisdictions are approving its recreational use. Two cannabinoid-based drugs are already FDA-approved in the U.S. as Schedule II and Schedule III controlled medications and several others are under investigation. Dental professionals should be aware of the changing legal landscape regarding medicinal and recreational marijuana use, its identified therapeutic and adverse effects, and oral health considerations.

Course Objectives:

• Cannabinoids, their receptors, and routes of administration;

• FDA-approved and investigational cannabinoid-based drugs;

• Diseases and conditions manageable with medicinal marijuana as allowed by law;

• Dental/oral considerations of the medicinal marijuana use;

• Future directions of research and oral/dental implications.

CODA DH Standards Met:

2-8b Biomedical science content must include content in anatomy, physiology, chemistry, biochemistry, microbiology, immunology, general and maxillofacial pathology and/or pathophysiology, nutrition and pharmacology.

2-13 Graduates must be competent in providing the dental hygiene process of care which includes:

• comprehensive collection of patient data to identify the physical and oral health status;

• analysis of assessment findings and use of critical thinking in order to address the patient’s dental hygiene treatment needs;

• establishment of a dental hygiene care plan that reflects the realistic goals and treatment strategies to facilitate optimal oral health;

• provision of patient-centered treatment and evidence-based care in a manner minimizing risk and optimizing oral health;

• measurement of the extent to which goals identified in the dental hygiene care plan are achieved;

• complete and accurate recording of all documentation relevant to patient care.

2-15 Graduates must be competent in communicating and collaborating with other members of the health care team to support comprehensive patient care.

2-19 Graduates must be competent in the application of the principles of ethical reasoning, ethical decision making and professional responsibility as they pertain to the academic environment, research, patient care and practice management.

2-20 Graduates must be competent in applying legal and regulatory concepts to the provision and/or support of oral health care services.

2-22 Graduates must be competent in the evaluation of current scientific literature.

2-23 Graduates must be competent in problem solving strategies related to comprehensive patient care and management of patients.

Canadian Competency:

• A3. Apply principles of risk reduction for client, colleague and practitioner safety, health and wellbeing.

• A6. Respect the autonomy of clients as full partners in decision-making.

• A7. Evaluate clients’ health and oral health status using determinants of health and risk assessment to make appropriate referral(s) to other health care professionals.

• B11. Function effectively within oral health and inter-professional teams and settings.

• F3. Use professional judgment and methods consistent with medico-legal-ethical principles to complete client profiles.

• F4. Identify clients for whom the initiation or continuation of treatment is contra-indicated based on the interpretation of health history and clinical data.

• F7. Discuss findings with other health professionals when the appropriateness of dental hygiene services is in question.

• F8. Prioritize clients’ needs through a collaborative process with clients and, when needed, substitute decision makers and/ or other professionals.

• H1. Recognize the influence of the determinants of health on oral health status.

• H5. Collaborate with community, interprofessional and intersectoral partners to achieve health promotion goals for individuals and communities.

• H5. Collaborate with community, interprofessional and intersectoral partners to achieve health promotion goals for individuals and communities.

Classroom Support Materials

Discussion questions:

1. What are the legal/ethical dilemmas when treating patients that list marijuana as one of their medications or as recreational use?

2. Discuss why is it important to know the side effects of marijuana use on the oral cavity?

3. Discuss the differences between plant based and synthetic forms of marijuana; and the medical uses of each.

4. Discuss the differences between state and federal regulations of marijuana use.

5. Discuss how being a schedule 1 drug impacts the ability to research marijuana's impact on society, health, and addiction.

6. Discuss what would constitute the "compassionate use" of marijuana.

Classroom activities:

1. Have a list of the currently used medical marijuana names and dosages and have students look up dental implications

2. Allow students to debate the legalization of marijuana.

3. Have students role play how to discuss marijuana use with a client.

Exam Questions:

1. Match the percentage of THC (mind altering component) to the available form of medical marijuana.

Dried leaves 9.6%, hashin (resin extract) 14.8%, and hash oil 66.4%

2. Which of the following compounds is actually derived from the marijuana plant?

A. phytocannabinoid B. synthetic cannabinoid C. endocannabinoid

Answer: A Rationale: B is man made and C is naturally occuring in our bodies

3. The CB1 receptors are located in the ______system and ______are located on immune cells and pheripheral nervous system.

Answer: Central Nervous System, CB2

4. The component of marijuana that causes the "high" felt by users is:

A. benzopyrene B. hashish C. THC D. hashish oil

Answer: C Rationale: THC is the component responsible for the high. Hashish is an extract of the marijuana plant's flower; hashish oil is concentrated hashish. Benzopyrene is a carcinogen contained in marijuana.

5. All the following are potential medical uses for marijuana except:

A. pain relief B. antiemisis C. dental extractions D. appetite enhancement

Answer: C Rationale: There has been no evidence of pain relief for dental extractions with the use of marijuana

6. Because medical marijuana is not legal in the eyes of the federal government, physicians may only authorize patients' use in states that have legalized marijuana.

A. True B. False

Answer: A Rationale: True--prescribing is not allowed by federal law. By using the word "authorize" the use is protected by the confidentiality of patient/provider communication.

7. Marijuana use is associated with which of the following oral conditions:

A. xerostomia B. periodontal disease C. dental caries D. taste alteration E. all of the above

Answer: E